Social Summit Fails to Treat Global Health Crisis

By Kalinga Seneviratne

COPENHAGEN, Mar 20 (IPS) - The recently-concluded World Summit
on Social Development may have called for access to primary
health care for all by the year 2000, but it failed to diagnose
the root causes of the global health crisis, non-governmental
organisations (NGOS) say.

They say the Summit sidestepped discussion of the
deterioration in health care policies worldwide, which they
trace to ill-advised policies for developing countries and
structural adjustment programmes (SAPs) that forced governments
to cut back on health budgets to meet macroeconomic targets.

At an NGO Forum meeting, David Werner of the U.S.-based
HealthRights group said these trends in global health tend to
undermine the 1978 Alma Ata Declaration, which says the pursuit
of health is inseparable from the struggle for a fairer, more
caring society.

NGOs say health policies around the world are under assault
by the World Bank's SAPs, which Werner says are the Bank's
attempts to enter the health policy area with conditionalities.

United Nations agencies are also casting a critical eye at
saps. The U.N. Children's Fund (UNICEF) issued a report at the
Social Summit seeking the reexamination of SAPs.

Anwarul Chowdhury, secretary of UNICEF's executive board,
said: ''They may say you have to bring in financial discipline
to address economic problems. But if it seriously brings down
living standards of common people, then the discipline is not
beneficial.''

''It's like saying the operation was successful but the
patient died. We would like it (SAP) reexamined to ensure that
social sectors are not affected,'' he pointed out.

''There can be no social development or sustained economic
growth without health,'' WHO director general Hiroshi Nakajima
said in his statement at the Summit. ''We must look beyond short-
term policies which provide minimal safety nets only, or we run
the risk of helping poverty become institutionalised.''

Another WHO official said saps and its health priorities are
causing untold suffering and deepening poverty in developing
countries.

''When we talk about privatisation, let's realise that health
is different. It cannot be bought and sold at commercial
rates,'' said Dr. Aleya Hammad, WHO special representative for
health policies, at a seminar attended by World Bank officials.

Health is a human rights issue ''whether or not it
contributes to economic development'', she pointed out.

David de Ferranti, director of the World Bank's Population,
Health and Nutrition programme, said real progress has been made
by countries that seriously tried to restructure their
economies.

He said the Bank invests more than 5 billion dollars a year in
basic services,''more than twice what goes to economic
reforms.''

But the University of Ottawa's Michel Chossudovsky said SAPs
have forced countries to cut spending on health and education so
much that internal economies have virtually collapsed.

SAPs have forced fuel price hikes, causing economic crises
that not only paralyse public health systems but hurt nutrition,
availability of drugs and marketing of produce, he added.

''The World Bank's solution is social safety nets, structural
adjustment with a human face,'' he said, adding that safety nets
were the official platform of the Social Summit.

But SAPs are ''designed to manage poverty at minimal cost to
the creditors'', Chossudovsky argued.

''It means you reduce commitment to universal programmes,
because the bank believes it is more equitable and efficient to
target vulnerable groups, the poor, and the universal funding of
health is only benefiting the rich,'' he said.

The hidden agenda is to disengage ministries of health and
reallocate money to debt servicing, he warned. Bank officials
argued that the Bank does not create economic crisis through
SAPs, but that SAPs were introduced precisely because countries
are in already deep economic crisis.

NGO delegates from Zimbabwe, the Philippines, Mexico and
Nicaragua also described SAPs' ill effects in their countries.

David Sanders, director of the public health programme at
South Africa's University of the Western Cape, said the decline
in real wages, removal of food subsidies and fees and levies
imposed on schools under SAPs have pushed down health standards
in Zimbabwe.

Filipino health worker Luz Bartolome said poor health
services are forcing midwives and nurses to give instructions
only for partial treatment. People are dying from simple
accidents and curable diseases, she added.

In Nicaragua, a report by the Centre for Information and
Advisory Services for Health said only 42 per cent of the
populace had access to health services in 1977, when the
Sandinistas came to power. This rose to 83 per cent in 1990, but
by 1993 only 55 per cent of new health equipment was working.

Said Manuel Palacios of Nicaragua: ''Now children are dying.
They don't eat enough food, don't go to school. After years of
World Bank programmes we see them as against us. They have made
women into prostitutes to buy food for their children.''